This invention will be discussed in particular in relation to the delivery and cannulation of thoracoabdominal stent grafts but the invention is not so limited. It may also, for instance, be used in relation to a laparoscopic port or access sheath.
Thoracoabdominal aneurysms are particularly difficult to treat due to the inclusion of four branch vessels (celiac artery, superior mesenteric artery, and two renal arteries). Endovascular devices are available which include four branches, but cannulation of each branch independently can be difficult and time consuming, exposing the patient to large amount of contrast and x-rays. Preloaded wires associated with a fenestrated stent graft and a delivery device have been demonstrated to greatly ease the process of cannulating the branches of the device. In the case of thoracoabdominal aneurysm, a fenestrated or side arm stent graft with four preloaded wires with catheters or sheaths are required for the four side branches or fenestrations. Since a preloaded delivery system including four lumens for four catheters or preloaded sheaths in the delivery device would be unacceptably large (28 Fr), an alternative option is to individually cannulate the branches using preloaded guide wires from a brachial access site. To accomplish this, the preloaded wires must be inserted from the femoral access with the main delivery and tracked through the abdominal and thoracic aorta, and out through the brachial artery.
PCT Patent Application Number PCT/US2011/029037 (published as WO 2011/116308) entitled “INTRODUCER WITH EXTENSION” lodged on 18 Mar. 2011 discloses arrangements for delivery of fenestrated or branched stent grafts using delivery devices incorporating preloaded guide wires and the teaching therein is incorporated herein in its entirety.
In one stage in the delivery process using such a device, a number, such as four, guide wires are delivered through the vasculature of a patient to exit at or near a shoulder from an access port to a brachial artery.
Once the preloaded wires are exposed from the sheath in the brachial arteries they are difficult to manage while achieving haemostasis. Two particular challenges arise: the wires can easily become entangled through tracking, and identification of each wire is difficult.
It is to overcome some of these problems that the present invention is directed or to at least provide the practitioner with a useful alternative.